RSS-Feed abonnieren
DOI: 10.1055/s-0031-1291181
Laparoscopic Inguinal Hernia Repair in Children with Transperitoneal Division of the Hernia Sac and Proximal Purse String Closure of Peritoneum: Our Modified New Approach
Publikationsverlauf
received 29. Mai 2011
accepted after revision 22. August 2011
Publikationsdatum:
14. Dezember 2011 (online)
![](https://www.thieme-connect.de/media/ejps/201106/lookinside/thumbnails/10.1055-s-0031-1291181-1.jpg)
Abstract
Objective:
To describe our results of laparoscopic transperitoneal division of the hernia sac with purse string closure of the proximal peritoneum for inguinal hernia repair in children.
Methods:
A retrospective case review of all patients undergoing laparoscopic herniorrhaphy with herniotomy by a single surgeon between January and August 2007 was performed evaluating perioperative and postoperative outcomes.
Technique:
A complete intracorporeal laparoscopic technique was utilized to inspect bilateral inguinal canals followed by circumferential division of the peritoneum at the deep ring (patent processus vaginalis) followed by purse string closure of the proximal peritoneum.
Results:
31 inguinal hernias were repaired laparoscopically in 26 patients (23 boys, 3 girls). Median age was 36 months (range 1–168 months). 22 children had unilateral inguinal hernia repairs including 2 recurrent hernias; 4 children underwent repair of bilateral inguinal hernias. Mean operating time for unilateral and bilateral inguinal hernia repairs were 48.5±14 min and 61±13.8 min, respectively. 2 patients with a preoperative unilateral inguinal hernia were found to have bilateral inguinal hernias upon laparoscopic examination which were repaired. Postoperative pain was minimal in 20 (77%) patients at discharge. Mean telephone follow-up at 8±9.6 months demonstrated no recurrences to date.
Conclusion:
Laparoscopic inguinal hernia repair with transperitoneal division of the hernia sac and purse string closure of the proximal peritoneum allows for a minimally invasive option for pediatric inguinal hernia repair that mimics open inguinal hernia repair. At medium term follow-up there have been no recurrences to date, high parent satisfaction, minimal scarring and good cosmetic results.
-
References
- 1 Dutta S, Albanese C. Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up. Surg Endosc 2009; 23: 103-107
- 2 Takehara H, Yakabe S, Kameoka K. Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J Pediatr Surg 2006; 41: 1999-2003
- 3 Harrison MR, Lee H, Albanese CT et al. Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: a novel technique. J Pediatr Surg 2005; 40: 1177-1180
- 4 Spurbeck WW, Prasad R, Lobe TE. Two-year experience with minimally invasive herniorrhaphy in children. Surg Endosc 2005; 19: 551-553
- 5 Jialin L, Hanxin Z, Xiaofang Y et al. Laparoscopic herniorrhaphy combined ligation of the hernial sac and suturation of the internal ring in children with indirect inguinal hernias. Surg Laparosc Endosc Percutan Tech 2007; 17: 95-98 discussion 98
- 6 Schier F, Montupet P, Esposito C. Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. J Pediatr Surg 2002; 37: 395-397
- 7 Schier F. Laparoscopic inguinal hernia repair – a prospective personal series of 542 children. J Pediatr Surg 2006; 41: 1081-1084
- 8 Chan KL, Tam PK. A safe laparoscopic technique for the repair of inguinal hernias in boys. J Am Coll Surg 2003; 196: 987-989
- 9 Becmeur F, Philippe P, Lemandat-Schultz A et al. A continuous series of 96 laparoscopic inguinal hernia repairs in children by a new technique. Surg Endosc 2004; 18: 1738-1741
- 10 Tsai YC, Wu CC, Yang SS. Minilaparoscopic herniorrhaphy with hernia sac transection in children and young adults: a preliminary report. Surg Endosc 2007; 21: 1623-1625
- 11 Saranga Bharathi R, Arora M, Baskaran V. Minimal access surgery of pediatric inguinal hernias: a review. Surg Endosc 2008; 22: 1751-1762
- 12 Wong DL H-EM, Wilson D, Winkelstein ML et al. Whaley and Wong’s Nursing Care of Infants and Children. 6 ed. St. Louis: Mosby; 1999
- 13 Tiryaki T, Baskin D, Bulut M. Operative complications of hernia repair in childhood. Pediatr Surg Int 1998; 13: 160-161
- 14 Saranga Bharathi R, Arora M, Baskaran V. Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS 2008; 12: 277-281
- 15 Koivusalo AI, Korpela R, Wirtavuori K et al. A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children. Pediatrics 2009; 123: 332-337
- 16 Chan KL, Hui WC, Tam PK. Prospective randomized single-center, single-blind comparison of laparoscopic vs. open repair of pediatric inguinal hernia. Surg Endosc 2005; 19: 927-932
- 17 Gad El-Moula M, Izaki H, El-Anany F et al. Laparoscopy and intersex: report of 5 cases of male pseudohermaphroditism. J Med Invest 2008; 55: 147-150
- 18 Riquelme M, Aranda A, Rodriguez C et al. Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptoorchidism: preliminary report. Pediatr Surg Int 2007; 23: 301-304
- 19 Palmer LS, Rastinehad A. Incidence and concurrent laparoscopic repair of intra-abdominal testis and contralateral patent processus vaginalis. Urology 2008; 72: 297-299 discussion 299
- 20 Kaya M, Huckstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg 2006; 41: 567-569